Since the early 21st century, Garra rufa have been integrated into a spa treatment where they feed on the skin of patients with psoriasis. While the doctor fish treatment has been found to alleviate the symptoms of psoriasis, the treatment is not curative, and no cure for psoriasis currently exists. The use of the fish as a spa treatment for the wider public is still widely debated on grounds of efficacy and validity.
Garra rufa occurs in the river basins of the Northern and Central Middle East, mainly in Turkey, Syria, Iraq, Iran, and Oman. It is legally protected from commercial exploitation in Turkey due to concerns of overharvesting for export. Garra rufa can be kept in an aquarium at home; while not strictly a "beginner's fish". For treatment of skin diseases, aquarium specimens are not well suited as the skin-feeding behavior fully manifests only under conditions where the food supply can be scarce and unpredictable.
When doctor fishes forage the slough off dead skin, they look for food which in the wild consists of aufwuchs. In both marine and freshwater environments the algae – particularly green algae and diatoms – make up the dominant component of aufwuchs communities. Small crustaceans, rotifers, and protozoans are also commonly found in fresh water and the sea, but insect larvae, oligochaetes and tardigrades are peculiar to freshwater aufwuchs faunas.
In 2006, doctor fish spa resorts opened in Hakone, Japan, Kangal, Turkey, and Umag, Croatia, where the fish are used to clean the bathers at the spa. There are also spas in resorts in China, Belgium, the Netherlands, South Korea, Singapore, Bosnia-Herzegovina, Hungary, various places in Greece (Chania being an example), Slovakia, India, Thailand, Cambodia, Indonesia, Malaysia, Philippines, Pakistan, Hong Kong, Bucharest, Prague (Czech Republic) and Sibiu (Romania), Madrid (Corralejo Fuerteventura Dr Fish) and Barcelona (Spain), Israel, France, Sweden, Denmark, Finland, Bahrain, Iceland, and Trondheim (Norway).
In 2008, two widely known doctor fish pedicure services were opened in the United States in Alexandria, Virginia, and in Milwaukee, Wisconsin. Wisconsin ordered the closure of the doctor fish service shortly after its opening. In 2010 the first spa opened in the United Kingdom in Sheffield.
The practice is banned in several of the states in the United States and Canadian provinces as cosmetology regulators believe the practice is unsanitary, with the Wall Street Journal saying that "cosmetology regulations generally mandate that tools need to be discarded or sanitized after each use. But epidermis-eating fish are too expensive to throw away". The procedure is legal in Quebec, with a few clinics in Montreal.
- "Search Results for: Garra rufa". Global Biodiversity Information Facility. Retrieved 28 June 2010.
- Zicha, Ondřej (2009). "BioLib - Garra rufa". BioLib. Retrieved 28 June 2010.
- "A medical study conducted by Martin Grassberger and Werner Hoch of the Medical University of Vienna, Austria, reported that exfoliation by doctor fish, Garra rufa, native to the hot springs at Kanghal, Turkey, when used in combination with ultraviolet (UV) light can clear the appearance of psoriasis. The treatment kept symptoms at bay for about eight months." Source: New Scientist. 7/14/2007, Vol. 195 Issue 2612, p52-52. 1p.
- "Lost Paradise lines up new attractions". Gulf Daily News. Retrieved 11 July 2012.
- Slack, Martin (10 March 2010). "Step right in – the Doctor Fish will see you now". Yorkshire Post. Retrieved 4 July 2010.
- Ban on Feet-Nibbling Fish Leaves Nail Salons on the Hook
- Galipeau, Silvia (8 July 2010). "Piscipédicurie: inusitée, controversée et non réglementée". La Presse. Retrieved 8 July 2010.